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Ten Days to Self-Esteem: The Leader's Manual
Ten Days to Self-Esteem: The Leader's Manual
Ten Days to Self-Esteem: The Leader's Manual
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Ten Days to Self-Esteem: The Leader's Manual

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Do you wake up dreading the day?
Do you feel ciscouraged with what you've accomplished in life?
Do you want greater self-esteem, productivity, and joy in daily living?

If so, you will benefit from this revolutionary way of brightening your moods without drugs or lengthy therapy. All you need is your own common sense and the easy-to-follow methods revealed in this book by one of the country's foremost authorities on mood and personal relationship problems.

In Ten Days to Self-esteem, Dr. David Burns presents innovative, clear, and compassionate methods that will help you identify the causes of your mood slumps and develop a more positive outlook on life. You will learn that

You feel the way you think: Negative feelings like guilt, anger, and depression do not result from the bad things that happen to you, but from the way you think about these events. This simple but revolutionary idea can change your life!

You can change the way you feel: You will discover why you get depressed and learn how to brighten your outlook when you're in a slump.

You can enjoy greater happiness, productivity, and intimacy—without drugs or lengthy therapy.

Can a self-help book do all this? Studies show that two thirds of depressed readers of Dr. Burns's classic bestseller, Feeling Good: The New Mood Therapy, experienced dramatic felief in just four weeks without psychotherapy or antidepressant medications. Three-year follow-up studies revealed that readers did not relapse but continued to enjoy their positive outlook. Ten Days to Self-esteem offers a powerful new tool that provides hope and healing in ten easy steps. The methods are based on common sense and are not difficult to apply. Research shows that they really work!

Feeling good feels wonderful. You owe it to yourself to feel good!

LanguageEnglish
PublisherHarperCollins
Release dateApr 16, 2013
ISBN9780062289735
Ten Days to Self-Esteem: The Leader's Manual
Author

David D. Burns, M.D.

David D. Burns, M.D., a clinical psychiatrist, conveys his ideas with warmth, compassion, understanding, and humor unmatched by any other writer in the self-help field. His bestselling Feeling Good: The New Mood Therapy has sold more than three million copies to date. In a recent national survey of mental health professionals, Feeling Good was rated number one—from a list of more than one thousand—as the most frequently recommended self-help book on depression. His Feeling Good Handbook was rated number two in the same survey. Dr. Burns's entertaining teaching style has made him a popular lecturer for general audiences and mental health professionals throughout the country as well as a frequent guest on national radio and television programs. He has received numerous awards including the Distinguished Contribution to Psychology Through the Media Award from the Association of Applied and Preventive Psychology. A magna cum laude and Phi Beta Kappa graduate of Amherst College, Dr. Burns received his medical degree from the Stanford University School of Medicine. He is currently clinical associate professor of psychiatry at the Stanford University School of Medicine and is certified by the National Board of Psychiatry and Neurology.

Read more from David D. Burns, M.D.

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  • Rating: 3 out of 5 stars
    3/5
    It'd be all too easy at first glance to mock this work based on the improbable promise of it's title and the all-too-happily grinning mug shot of its turtlenecked author, Dr. Burns, so I won't, other than to say I can see where SNL alum, Al Franken, got his "Stuart Smalley" inspiration.Nevertheless, there are good psychological exercises/question-and-answers throughout this introductory workbook designed to foster intellectual/interrelational insight and emotional growth, particularly for individuals who've struggled with feelings of low self-esteem and depression for whatever reasons. Particulary helpful in a group therapy setting as a means of providing a framework/structure for the therapeutic setting. I would recommend it for its hands-on practical value, though I think its title is a trifle disengenuous. Self-esteem, for those who've lacked it, takes years, not days to develop.
  • Rating: 3 out of 5 stars
    3/5
    It'd be all too easy at first glance to mock this work based on the improbable promise of it's title and the all-too-happily grinning mug shot of its turtlenecked author, Dr. Burns, so I won't, other than to say I can see where SNL alum, Al Franken, got his "Stuart Smalley" inspiration.Nevertheless, there are good psychological exercises/question-and-answers throughout this introductory workbook designed to foster intellectual/interrelational insight and emotional growth, particularly for individuals who've struggled with feelings of low self-esteem and depression for whatever reasons. Particulary helpful in a group therapy setting as a means of providing a framework/structure for the therapeutic setting. I would recommend it for its hands-on practical value, though I think its title is a trifle disengenuous. Self-esteem, for those who've lacked it, takes years, not days to develop.

Book preview

Ten Days to Self-Esteem - David D. Burns, M.D.

cover-image

TEN DAYS TO SELF-ESTEEM

THE LEADER’S MANUAL

DAVID D. BURNS, M.D.

CONTENTS

AUTHOR’S NOTE

PREFACE

ACKNOWLEDGMENTS

INTRODUCTION

ABBREVIATIONS OFTEN USED IN THIS MANUAL

GENERAL INSTRUCTIONS FOR LEADERS

STEP 1: THE PRICE OF HAPPINESS

STEP 2: YOU FEEL THE WAY YOU THINK

STEP 3: YOU CAN CHANGE THE WAY YOU FEEL

STEP 4: HOW TO BREAK OUT OF A BAD MOOD

STEP 5: THE ACCEPTANCE PARADOX

STEP 6: GETTING DOWN TO ROOT CAUSES

STEP 7: SELF-ESTEEM—WHAT IS IT? HOW DO I GET IT?

STEP 8: THE PERFECTIONIST’S SCRIPT FOR SELF-DEFEAT

STEP 9: A PRESCRIPTION FOR PROCRASTINATORS

STEP 10: PRACTICE, PRACTICE, PRACTICE!

APPENDIX A: ADDITIONAL LEADER’S DATA SHEETS

APPENDIX B: PERSONAL HISTORY FORM FOR INTAKE EVALUATIONS

APPENDIX C: ADDITIONAL PROGRESS NOTES

APPENDIX D: SAMPLE CONSENT FORMS

TRAINING FOR GROUP LEADERS

SEARCHABLE TERMS

ABOUT THE AUTHOR

OTHER BOOKS BY DAVID D. BURNS

COPYRIGHT

ABOUT THE PUBLISHER

AUTHOR’S NOTE

The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with a psychiatrist, psychologist, or other mental health professional. All matters regarding your mental health require professional supervision.

The names and personal details of the patients mentioned in this book have been changed to protect their identities.

Individuals wishing to contact the author may do so at the following address:

David D. Burns, M.D., and Associates

c/o Presbyterian Medical Center of Philadelphia

39th and Market Streets

Philadelphia, PA 19104

PREFACE

The basic principles of cognitive therapy are quite straightforward:

•  Our thoughts, not external events, create our moods.

•  Distorted, illogical thoughts and self-defeating beliefs lead to painful feelings such as depression, anxiety, and anger.

•  By changing these negative thoughts, we can change how we feel.

For many years in my clinical practice, I have struggled to make these principles come alive. How can we best help people to recognize the crucial connections between the ways they think, feel, and behave? How can we help them to use this new knowledge to overcome depression and lead happier and more productive lives?

Therefore, I was delighted when Dr. David Burns, my friend and colleague, asked me to collaborate with him in developing groups based on Ten Days to Self-esteem. Since the implementation of this program at the Presbyterian Medical Center of Philadelphia eighteen months ago, we have seen it blossom in ways that we could not have imagined. To date, over six hundred patients who felt discouraged and hopeless have participated in this program.

We first pilot-tested Ten Days to Self-esteem at The Residence, a short-term inpatient program with an average length of stay of seven to ten days. Many of the patients at The Residence have relatively little formal education and suffer from dual diagnoses—with severe emotional disorders as well as alcohol or drug abuse. Prior to implementing Ten Days to Self-esteem, a less-structured treatment model had been tried with only limited success. The Residence was still struggling in its infancy and many of the staff members were pulling in different directions. This setting was a real challenge to the efficacy of Ten Days to Self-esteem!

Initially, many patients and staff members expressed feelings of skepticism and often frank disbelief that the program would work. Dr. Burns and I shared some feelings of uncertainty as well. We were all concerned that the techniques might be too sophisticated for some of our lower-functioning patients who could not even read or write. We were also quite aware that these patients had real and severe problems in daily living, and might not readily accept the idea that their negative feelings resulted from distorted thinking patterns and self-defeating attitudes.

To our great surprise, the program has far surpassed our expectations. With a little bit of flexibility, creativity, and compassion, we have been able to connect with many patients who previously appeared to be unreachable. We constantly receive letters of gratitude from patients who tell us that, for the first time, they truly understand why they became depressed and what they can do to make real changes in their lives—not tomorrow, next month, or next year, but now! The impact on the nurses, counselors, and other staff members has been equally positive. They now work together as a team with an effective, integrated treatment program. Referrals to The Residence and the census are up, and the facility has become a source of pride for the medical center.

In addition to our inpatient experience, we have also pilot-tested Ten Days to Self-esteem in outpatient groups consisting primarily of individuals from the higher social and economic brackets. In this setting, our initial concerns were a little different. We worried that there might not be enough meaty clinical material in each session for people who were intellectually and psychologically sophisticated.

Again, not true! We were pleasantly surprised to discover that the individuals in the outpatient programs dug into the material enthusiastically. In fact, they frequently had so much to chew on and digest that we found ourselves running out of time at the end of each two-hour session. The issues have been so profound and exciting to the participants that, once they begin, it is difficult to get them to stop and go home! In almost every case the outpatient participants, like the inpatients at The Residence, have reported dramatic reductions in depression scores, new insights into the nature of self-esteem, and profound changes in their attitudes and beliefs.

A unique gift of Ten Days to Self-esteem is that it takes the ideas and techniques of cognitive therapy from the dry intellectual level to a more emotional and personal level. As the participants in these groups discover how to modify their own negative thinking patterns, they feel a sense of excitement and develop a new philosophy of living that is more vibrant and compassionate. Observing and directing this process has been inspirational for me as a group leader and equally rewarding for the participants. It is this contribution that patients and group leaders will find the most rewarding and long lasting.

With the current movement toward briefer psychotherapies and managed care in the delivery of mental health services, there is great pressure to develop cost-effective, time-limited treatment programs. Instead of regretting what we can’t do because of limited funding, those of us who are involved with Ten Days to Self-esteem see this as a challenge to focus on what we can do. These are exciting times for change. This program will be treasured by any clinician or educator who is looking for new, creative ways to help individuals who are suffering from emotional problems such as depression and anxiety.

The experience that we have accumulated by running Ten Days to Self-esteem for a wide variety of populations has greatly enriched this Leader’s Manual. Whether you are an experienced or novice group leader, the guidelines, tips, and suggestions here will prove invaluable. We anticipate that each group leader will re-invent this basic program by adding his or her talents and insights. However, even if one follows this program literally by the book, it has been our experience that the group will take on a momentum of its own that will make for an exciting and rewarding experience.

With these tools in your hands, you are about to embark on an exciting journey, guiding people from all walks of life toward greater self-esteem and happiness. You will find that the exercises in Ten Days to Self-esteem are so numerous and so varied that they will fit most of your clinical needs. You can use these exercises like a musician working with a rich score. I anticipate that as you add your own unique contributions and style when interpreting this program, you will discover a beautiful melody unfolding and experience the immense satisfaction of bringing greater self-esteem to others.

—BRUCE S. ZAHN, M.A.

Director of Psychological Services

Presbyterian Medical Center of Philadelphia

ACKNOWLEDGMENTS

I would like to thank my close friend and colleague Bruce S. Zahn, M.A., director of psychological services at the Presbyterian Medical Center of Philadelphia, for invaluable assistance in the preparation of this manual. Bruce has provided numerous creative suggestions as well as incredible moral support.

I would like to thank Diane Kiddy, M.S.S., vice president of behavioral medicine, and I. Donald Snook, Jr., president of the Presbyterian Medical Center, for persistent encouragement in the development of this program. I am also indebted to Carol Persons, M.D., medical director of The Residence at the Presbyterian Medical Center, and Elizabeth Dean, program administrator at The Residence, for support of my efforts.

I would like to thank the Reverend Dick Hamlin, Dr. Dennis Hunter, and Jan Robinson at the Shepherd of the Valley Lutheran Church in Phoenix, who helped to pilot-test a prototype of this program with the members of their congregation. I am also grateful to Michael Greenwald, Ph.D., a clinical psychologist in Pittsburgh, for consultation and for supervision of several additional pilot tests of this program throughout the country.

Finally, I would like to thank Melanie Burns, my wife, colleague, and friend, for brilliant suggestions about the editing and tone of this manuscript.

The contributions of all of these individuals have been invaluable and deeply appreciated. Thank you!

INTRODUCTION

This Leader’s Manual will show you how to develop a short-term, structured group program entitled Ten Days to Self-esteem. Ten Days to Self-esteem consists of ten sessions that focus on the causes and cures for problems such as low self-esteem, feelings of inferiority, perfectionism, and procrastination. Participants learn specific skills to overcome depression and develop greater joy in daily living.

Any qualified mental health professional or trainee can lead the groups, including psychologists, psychiatrists, social workers, counselors, mental health technicians, school counselors, psychiatric nurses, and pastoral counselors. Participants can be students, psychiatric patients, or virtually anyone else.

These self-esteem training groups can be conducted in a variety of settings:

1. High schools and colleges: Depression, suicide, and loneliness afflict many young people. The Ten Days to Self-esteem groups are ideal for health classes in high schools and for personal growth classes and psychology courses in colleges. The program is also ideal for counseling centers in high schools and colleges. The groups represent exciting possibilities for educating a new generation of young adults with the attitudes and skills they will need to prevent depression and enhance productivity and self-esteem throughout their lives.

2. Graduate schools and professional training programs: Graduate students in nursing, social work, counseling, psychology, and psychiatry can participate in these groups and subsequently lead groups for patients. This experience will give the trainees a personal growth experience as well as the opportunity to master cognitive, behavioral, and interpersonal therapy techniques.

3. Hospitals, residential treatment facilities, and day treatment programs: One to three group sessions can be scheduled daily to create a rich and rewarding therapeutic environment. The program can have strong positive effects on staff members’ morale because they will see rapid, tangible changes in their patients.

4. Twelve-step programs and other self-help groups: Ten Days to Self-esteem can be easily integrated into the programs of established self-help organizations such as Alcoholics Anonymous, Recovery, Inc., Emotions Anonymous, CODA (Co-Dependents Anonymous), and others. Ten Days to Self-esteem is not intended to compete with these groups, which have been enormously helpful for so many people suffering from alcoholism, drug addiction, or emotional disorders. Rather, the practical coping skills described here can enhance and strengthen these groups by providing a richer and more exciting menu of opportunities for the members.

5. Managed health care: HMOs and other managed health-care delivery systems are under increasing financial pressure. Many insurance companies now offer extremely limited reimbursement for psychotherapy. Ten Days to Self-esteem can dramatically improve the quality and quantity of therapy per dollar of available funding.

6. Private and public outpatient clinics: Ten Days to Self-esteem can enhance the quality of care and help to attract clients. Many people want to participate in a time-limited, upbeat training program that targets a specific problem such as depression, anxiety, marital conflict, or an addiction.

7. Churches and synagogues: Psychotherapy and religion have been at odds during much of the twentieth century. However, the ideas and techniques in Ten Days to Self-esteem are highly compatible with nearly all religions. Any congregation can offer them as a part of the outreach program for its members as well as for the surrounding community. It will be relatively easy for leaders to point out the connections between what the participants are learning and various scriptural passages.

8. Corporations: Ten Days to Self-esteem can be invaluable for employee assistance programs to help individuals with emotional and interpersonal problems. The program can also be offered in a workshop format for professional training and personal growth for the staff.

9. Prisons and correctional facilities: Ten Days to Self-esteem can be offered in prisons and in the psychiatric hospitals that serve them. The techniques are easy to understand, based on common sense, and down-to-earth. The groups convey a nonjudgmental message and directly address the deficiencies in self-esteem and interpersonal relationships that are so common in this population.

10. Nursing homes: Although severely impaired individuals with Alzheimer’s disease would not be good candidates for Ten Days to Self-esteem, many people in nursing homes can benefit greatly from the groups. The groups can boost morale and break the cycle of loneliness and isolation that afflicts so many older people. Weekly groups for patients and their families together can help to improve communication and reduce feelings of guilt, frustration, and rejection.

Ten Days to Self-esteem is the first of three modules that I have developed. The leader’s manuals and participant’s workbooks for the two additional modules will be published subsequently.

The second module focuses on intimacy and personal relationship problems. The group members receive intensive training in self-expression and listening skills that can help them develop more satisfying relationships with their spouses, family members, friends, and colleagues at work.

The third module focuses on anxiety disorders. Participants learn how to overcome

•  chronic worrying and nervousness

•  anxiety and panic attacks

•  shyness and social anxiety

•  public speaking anxiety

•  test and performance anxiety

•  phobias such as agoraphobia or the fear of heights

•  obsessive-compulsive illness

•  and more

This is a challenging time for mental health professionals. We are faced with significant cutbacks in funding for psychological and psychiatric services from insurance companies, HMOs, Medicare, and Medicaid, as well as other managed health care programs. Therapists are often told to discharge severely disturbed inpatients after only five to ten days of treatment and to limit outpatient therapy to just a handful of sessions. At the same time, we must provide solid evidence to prove that the therapy is effective! Instead of fearing or resisting these sweeping changes, we can take this as an opportunity to develop innovative, cost-effective short-term treatments that will offer real help to the great majority of patients.

I am pleased that you are interested in Ten Days to Self-esteem. As you develop this program, you will be breaking new ground for people suffering from depression, loneliness, anxiety, and addictions who wish to enrich their lives and feel good about themselves once again.

ABBREVIATIONS OFTEN USED IN THIS MANUAL

GENERAL INSTRUCTIONS FOR LEADERS

This Leader’s Manual contains clear and detailed instructions for every session in this program. As a result, your very first experience running Ten Days to Self-esteem should be reasonably smooth and successful, even if you do not have extensive previous experience with these methods.

This section tells you how to set up the Ten Days to Self-esteem groups. You might want to begin by reading the descriptions of several of the sessions, beginning of this Leader’s Manual, and then come back to this section. As you read, you will be able to picture yourself leading a group. This experience will place the administrative details discussed here in a live context.

The instructions for each step are easy to follow and have been applied by my colleagues and me in many different settings. Once you have run a group, you will get a feeling for what works and what does not work for your particular group. As you lead the group, you will probably have many creative ideas on how to modify the format to meet the needs of the population you are serving.

SUPPLIES YOU WILL NEED

All you will need to run a group successfully is a quiet room with comfortable chairs for the participants and a coffeepot for the break. The room should ideally be large enough so you can break up the group into small teams of two to six members at times for specific exercises. You will also need a flip chart, blackboard, or overhead projector.

SUPPLIES THE PARTICIPANTS WILL NEED

The participant’s workbook is called Ten Days to Self-esteem. This workbook includes all the exercises, self-assessment tests, self-help forms, and other supplemental materials that the participants will need. Participants will use this workbook during each session and will do the self-help assignments in it between sessions. The exercises and charts in the workbook will make it easy for you to run the groups smoothly and professionally. This workbook is widely available in bookstores. You can order a copy of the Ten Days to Self-esteem workbook with the order form at the end of The Leader’s Manual, or you can order copies in quantity for your group at a discount by calling the publisher at 1-800-821-1513.

MEMBER MIX

You will need to think about the types of individuals who will participate in your group. Although the groups can be adapted effectively for men and women with a broad range of ages, diagnoses, intelligence levels, and social and economic backgrounds, a reasonable degree of uniformity within any group is desirable. Participants should have enough similarity to permit bonding and rapport to develop. For example, it is not wise to mix individuals with extremely severe emotional difficulties (such as schizophrenia) together with people with very mild problems who are taking the group for personal growth purposes.

INCLUSION AND EXCLUSION CRITERIA FOR THE GROUPS

The following guidelines can help you decide which participants may need individual therapy outside the group. The guidelines will also help you identify applicants who may not be suitable for Ten Days to Self-esteem.

These guidelines apply primarily to groups in outpatient settings. You can include more seriously disturbed individuals when you run the groups in inpatient or residential treatment settings or day treatment programs. For example, at the Presbyterian Medical Center of Philadelphia we have had excellent success in using these groups with extremely disturbed inpatient populations, including individuals with schizophrenia, drug abuse problems, and severe mood and personality disorders. Many of these patients have been enthusiastic about the program and have expressed gratitude to the staff who run the groups. However, you may have to simplify the groups and use your creativity when you are working with more disturbed populations, as described.

In an outpatient setting, you generally should not include people with these problems:

1. Psychotic symptoms: This includes individuals who are delusional, out of touch with reality, hearing voices, hallucinating, or behaving inappropriately.

However, there are exceptions to this rule. In day treatment programs, or in outpatient groups consisting entirely of schizophrenics, you can run a simplified version of this program quite successfully, as long as the patients have individual psychiatric management so that medications can be prescribed if indicated.

2. Chronicity: People who have long-standing problems with depression or anxiety are excellent candidates for the groups but may also need individual psychotherapy and/or medication treatment.

3. Severity: If someone has overwhelming difficulties with feelings of depression, anxiety, guilt, or anger, then one-to-one therapy may be indicated.

4. Low capacity to function: If a mood problem significantly interferes with an individual’s capacity to relate to others or to function adequately at home, school, or work, professional treatment is indicated. For example, if someone is so depressed that he or she refuses to get out of bed, that individual would not be likely to benefit from the group and would be a burden to the other members.

5. Low motivation: The groups are intended for people who want to be in them. Anyone who feels coerced to attend will feel resentful and may sabotage the group. This is why people are asked to make a significant commitment to the group at the beginning. For example, the Self-help Contract of the participant’s workbook makes it clear that members will have to work hard doing self-help assignments between sessions.

6. Hopelessness and suicidal impulses: Some depressed people feel like giving up because they are convinced that there is no solution to their problems. Anyone who is actively suicidal needs immediate one-to-one therapy and may require hospitalization. Such individuals may be a danger to themselves and would be a continual source of distress to the group and to the leader.

Most people with feelings of depression have the thought at times that life is not worth living or that they’d be better off dead. These thoughts are perfectly natural and need not exclude anyone from the group. The crucial issue is whether an individual has actual intentions and plans to commit suicide. If a person has a strong desire to die, and there are no strong reasons (such as religious beliefs or a commitment to the family) preventing him or her from committing suicide, then immediate evaluation and treatment by a psychiatrist or psychologist is needed.

7. Drug or alcohol intoxication: Individuals who are being treated for drug or alcohol abuse are good candidates for the groups, but participants who are intoxicated may not attend any sessions. Recovering alcoholics and drug abusers should be encouraged to attend AA or NA (Narcotics Anonymous) meetings along with Ten Days to Self-esteem.

Some participants may already be receiving individual therapy. It is a good idea to ask them to obtain consent from their therapists to join Ten Days to Self-esteem. You can enhance the effectiveness of both treatments by consulting with the other therapist. The participant’s perception of teamwork between the two therapists will be extremely helpful. This can prevent splitting, and the participant will find it more

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